Scientific Validation of Parasurgical Procedures A Review Article

International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
@ IJTSRD | Unique Paper ID – IJTSRD47653 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 1414
Scientific Validation of Parasurgical Procedures - A Review Article
Dr. S. Tameem Ansari1
, Dr. Syeda Ather Fathima2
, Dr. Shivalingappa J. Arakeri3
,
Dr. Mohasin Kadegaon4
, Dr. Geethanjali Hiremath4
1
PG Scholar, 2
Principal, 3
Professor & HOD, 4
Assistant Professor,
1, 3, 4
Department of PG Studies in Shalya Tantra,
1, 2, 3, 4
Taranath Government Ayurvedic Medical College, Ballari, Karnataka, India
ABSTRACT
The parasurgical procedures are the specialized procedures which are
described by Acharya Sushruta “The Father of Surgery”. These are
the separate procedures other than major surgical procedures called
Ashtavidha Shastra Karmas. These procedures have special
indications other than major surgical procedures like children,
sensitive patients etc, which are more helpful & effective where
medicine & surgery will not give the expected results. These
parasurgical procedures include Ksharakarma, Ksharasutra,
Agnikarma, Raktamokshana & so on. As these procedures are results
oriented & most popular among Ayurvedic fraternity. So there is a
need to explore these techniques on the modern scientific background
so that these procedures should be well practiced on scientific
background with confidence, so that it can contribute more to the
present Ayurvedic surgical knowledge. Keeping this in background,
here an attempt is made to substantiate the scientific validation of
parasurgical procedure is made.
KEY WORDS: Parasurgical procedures, Ksharakarma, Ksharasutra,
Agnikarma, Raktamokshana- Jalaukacharana, Siravyadha, Prachana,
Shringa & Alabu
How to cite this paper: Dr. S. Tameem
Ansari | Dr. Syeda Ather Fathima | Dr.
Shivalingappa J. Arakeri | Dr. Mohasin
Kadegaon | Dr. Geethanjali Hiremath
"Scientific Validation of Parasurgical
Procedures - A Review Article"
Published in
International
Journal of Trend in
Scientific Research
and Development
(ijtsrd), ISSN: 2456-
6470, Volume-5 |
Issue-6, October
2021, pp.1414-1419, URL:
www.ijtsrd.com/papers/ijtsrd47653.pdf
Copyright © 2021 by author (s) and
International Journal of Trend in
Scientific Research and Development
Journal. This is an
Open Access article
distributed under the
terms of the Creative Commons
Attribution License (CC BY 4.0)
(http://creativecommons.org/licenses/by/4.0)
INTRODUCTION:
Shalya tantra is one of the most specialized branch of
Ashtanga Ayurveda where Acharya Sushruta who is
worshipped as the “The Father of Surgery” has
described various treatment modalities relating to
both surgical and parasurgical procedures. It has
widely been practiced in the various clinical settings
depending on the training and exposures of the
physician. With renewed interest in the parasurgical
procedures in the recent times Agnikarma,
Ksharakarma, Ksharasutra, Raktamokshana-
Jalaukacharana, Siravyadha, Prachana, Shringa and
Alabu have gained foremost appraisal to attempt
treatment effectively in the management of different
surgical conditions.
Kshara is the substance which is obtained by burning
some specific medicinal plants & the Ash is
processed in a systemic manner. It is of 2 types1
, 1)
Paneeya Kshara, 2) Pratisaaraneeya Kshara. Kshara is
best among Shastra & Anushastra2
. Pratisaaraneeya
Kshara is useful in Dermatoses, Hyperkeratosis,
Ringworm etc Skin conditions, Fistula In Ano,
Tumors, Hemorrhoids, Indolent ulcers & so on3
.
Along with Pratisaaraneeya Kshara, Ksharasutra &
Kshara Varti are widely used for the management of
Bhagandhara, Nadivrana & Dushtavrana also.
Agnikarma is used in curing different diseases & has
got world wide popularity because of its simple
administration & efficacy in variety of disorders. It is
unique form of therapy performed with the help of
agni4
which can cure those diseases also, which can’t
be cured by Bheshaja, Kshara & Shastrakarma5
. It is
described to be superior to Ksharakarma as the
diseases treated by it do not relapse & moreover those
incurable by medicine, operations & caustic yield to
it. It is specially indicated in Hemorrhoids, Tumors,
Fistula in Ano, severe pain in skin, muscle, vein,
ligaments, joints & bone caused by aggravated vata6
etc.
IJTSRD47653

International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470
Raktamokshana therapy is the blood cleansing &
purification therapy. It is the prime process of blood
detoxification. It is one among the shodhana karma
according to Acharya Sushruta & Charaka. Skin
diseases, Granthi, Shopha, Raktajanya diseases do not
occur in those persons who are subjected to proper
bloodletting time to time7
.
The specific indications of Jalaukacharana are Pitta
dushta raktaja rogas, Gulma, Arsha, Vidradhi,
Kushta, Vatarakta, Galarogas, Netrarogas, Visha and
Visarpa8
.
The specific indications of Siravyadha are Vidradhi
except tridoshaja, Arbuda, Granthi, Stanarogas, and
Dantapupputa etc Kshudrarogas are indicated.
Vagbhata added those conditions arise due to Pitta &
Kapha, diseases which do not respond to Sheeta-
Ushna, Snighda- Rooksha treatment should be
understood as being born of Dushta Rakta &
Raktamokshana should be performed9
.
Prachana is indicated in Pindita Rakta, Twak Rogas,
Indralupta, Kshudrarogas, and Utsedayukta Vrana.
Shringa is indicated in Vata dushta raktaja rogas,
while Alabu is indicated in Kapha dushta raktaja
rogas10, 11
.
SCIENTIFIC VALIDATION OF
PARASURGICAL PROCEDURES
1. Action of Kshara in Specific Diseases:
Haemorrhoids:
Causes Coagulation of proteins in Haemorrhoidal
plexus (Chemical Cauterization of Pile masses)
Disintegration of Haemoglobin into Haem and
globin Blackish brownish discharge
Necrosis of Tissues Sloughing in 3-7 days
Fibrosis of Plexus & Scar Tissue Formation
Adhesions of Mucosal, Sub mucosal coats
Prevention of further dilatation of veins &
Prolapse of regional Mucosa of anus.
Permanent radical obliteration of Hemorrhoids &
wound healing within 21 days.
Rectal Prolapse:
Induces aseptic fibrosis of the rectal mucosa and
adheres it properly
During healing it causes cicatrization, narrowing
of lumen and strengthens the anorectal ring.
Fistula-in-Ano:
In Low fistulas, after fistulotomy, helpful for quick
healing by debridement of fibrous tissue and avoids
recurrence.
Dushtavrana:
Best Substitue for Surgical debridement of Ulcer.
It acts only on the deranged, unhealthy growth &
hypertrophied tissues.
Promotes fast epithelization, increase collagen
deposition, reduced exudates and reduced edema
and promotes granulation tissue formation.
Tonsilitis:
Minute burns Coagulation of muco-
lymphoid tissues Reduces the intra-cellular space
& aggregates the lymphoid tissues Stimulates
fibrosis of tonsillar tissue reduces size of the
tonsils.
2. Action of Ksharasutra12,13,14,15,16
:
Fistula In Ano & Pilonidal Sinus:
Helps in Cutting, Curetting, Draining and Healing
of the fistulous track.
Caustic action - Destroys and removes unhealthy
tissues & Promotes healing of the fistulous track.
Controls infection by the microbicidal action.
Facilitate the drainage of Pus in fistulous track
and helps in healing.
Theories:
Theory of Chemical Cauterization.
Theory of Antimicrobial Effect.
Mere Mechanical cut & Open theory.
Novel technique of local drug delivery.
Action of Ksharasutra:
Days Action of Ksharasutra
1
Local irritation and discomfort in the
anal region.
2-4
Inflammation (local redness, burning
sensation).
4
Necrosis: Kshara comes in contact with
fistulous tract the stage of micro necrosis
begins.
5-6
Shedding of unhealthy granulation tissue
due to necrosis (cutting of fistulous
tract), fibroblastic proliferation.
7
The Haridra coating of new Ksharasutra
comes in contact with the fistulous tract
which completes the healing.
Low recurrence: The Ksharasutra allows invisible
minor ramifications to drain in to the major tract by
healing themselves totally before the major tract is
cutoff.
Hemorrhoids
Chemical Cauterization & Mechanical
Strangulation of the blood vessels.
Local gangrene of the pile mass
Ischemic necrosis and debridement of unhealthy
tissue.
Sloughing of mass & Healing of wound.

3. Agnikarma
Possible Scientific Explanations:
1. Gate control therapy17
: Pain sensations are transferred by two types of fibers. “A” fibers (stimulated by
heat, cold and touch) and “C” fibers (stimulated by pain). Here the gate mechanism is blocked by stimuli
from A fiber, so the pain will not be felt.
2. According to scientist Dr. Ven Hanff18
: The place where heat burns the local tissue metabolism is
improved and thus it leads to increased demand of oxygen and nutrient of the tissue. This causes enhanced
delivery of nutrients and more efficient removal of waste products, hence speeding up the natural process of
repair.
3. Effect of heating on nerves19
: Heat appears to produce definite sedative effects. The effect of heat on
conduction has still to be thoroughly investigated but a physiological explanation has been offered by Sidney
Licht (1965), there is evidence that any sensory excitation reaching the brain simultaneously with a pain
excitation results in the pain impulse being more or less attenuated. Pain receptors of skin and motor end
plate stimulated at 450
C. Pathway for pain and thermal signals run parallel and ends into same area but only
stronger one can felt. Therefore complete exclusion of pain impulse by heat occurs.
4. Counter irritation theory20
: A counter irritant stimulates sensory nerve endings and relieves pain.
5. Effect on muscle tissue21
: Heat induces muscle relaxation.
6. TENS effect22
: Trans-electric nerve stimulation relieves pain by burning superficial nerve endings.
4. Rakta Mokshana
Siravyadha23
:
It is predominantly indicated in Pitta, Rakta & Kaphaja vyadhis or when pitta or kapha is in anubhandha to
vata dosha.
Helps to remove the Avarana of Pitta & Kapha dosha giving way for Anuloma Gati of Vititated vata.
Modern View24
:
Stimulation to large sensory fibers from peripheral tactile receptors depresses the transmission of pain
signals either from the same area of the body or even from many segments. This results in local inhibition.
It reduces intravascular pressure & volume which will reduces pain and swelling.
It reduces breakdown of RBC in turn reduces pigmentation & Itching.
Jalaukavacharana
The main constituents of the saliva of jalauka and their actions are as follows25
.
Constituents Mode of action
Hirudin
Most powerful Anti-coagulant, works as Diuretic & Antibiotic. (Other Anti-
coagulants: Hementin, Hementerin, Annastatin)
Bdellin Protease inhibitor like trypsin chymotrypsin or plasmin
Eglin Digestive protease
Apyrase &
Destabilase
Powerful platelet Anti-aggregate factor
Hyaluronidase Enzyme which breaks hyaluronic acid responsible for connective tissue bonding.
Anti- Elastase Degrade cutaneous elastastin at the level of Skin
Piavit Leech prostanoids and has protective antithrombotic effects
Haementin &
Orgelase
Have Hyperaemistic effect
Lipase, Estarase Lipolytic substance
Varicose Veins:
Anticoagulant effect: Hirudin by binding to thrombin. Also helps in reducing blood thickness and promotes
optimum blood flow. Calin by binding to collagen
Clot Dissolving effect : Detsabilize Breakup of Fibrin & Thrombolytic effect
Anti-Inflammatory Effect : Bdellins & Eglins Inhibits trypsin & Plasmin
Bacteriostatic & Anaesthetic effect:
Anesthetic like Substances Relieve pain
Bacteria inhibiting substances Inhibits growth of Bacteria

Peripheral Vascular Diseases:
Constituents Mode of action
Hirudin Reduces factor VII -> Easy blood flow
Apyrase (Platelet
anti aggregate factor)
Thrombus Destruction
Eglin Acts as Anti-Oxidant by Reducing inflammation
Esterase Prevents Hypercoagulation & Reduce fat flow
Bdellin
Digests foreign protein matrix & also digests undue intimal wall of the blood
vessel
Hyalurodinase Diffuses the blood for free flow and excrets antibiotication
Histaminase Produces Vasodilatation action & Promotes regeneration
Dushtavrana:
Hirudin improves Microcirculation
Hyalurinidase Facilitates penetration & diffusion of pharmacologically active substances into the tissues
Trypsin, Plasmin Reduces pain during bite
Histamine Increase blood flow
Acetylcholine Vasodilator, Removing abnormal cells, reducing the bacterial load & formation of healthy
granulation tissues.
All together Microcirculation within the wound Bio-debridement prolonged oozing Healthy
granulation tissue formation.
Thrombosed Hemorrhoids:
Hirudin & Hyaluronidase capillary tissue exchanging Improves blood circulation
Thrombolytic action Dissolution of the organized blood clots
Reduces swelling, Reduces pain.
Plastic & Reconstructive Surgery:
Venous occlusion Thrombus Formation Flap necrosis
To relieve venous congestion leeches are used.
Alleviates tissue capillary pressure & local anticoagulation through
Active suction
Secretion of Vasoactive substance(Hirudin)
Passive oozing from bite wound
Better acceptance of flap: improving micro-circulation.
Reduced the rate of resection
Leech Therapy in Modern Science:
Anti-Inflammatory Action
Anti-Metastatic action
Anti-Hyperglycemic action
Anticoagulatory effect
Leech therapy in Dentistry
Leech therapy in Eye & ENT disorders
Leech therapy in Reconstructive surgeries
Shringa & Alabu:
Negative Pressure Stimulates circulation Vasodilatation Increasing blood supply Increasing the
metabolism faster elimination of waste substances.

Cupping Therapy26
:
Prachana:
Prachana stimulates the accumulation of mast cells at the site & helps in improvement of circulation.
Prachana damages the superficial layers of skin and thus helps in rapid penetration of drugs.
DISCUSSION:
Acharyas have elaborately explained indication, mode
of action of these parasurgical procedures in their
treatises. But knowledge is only limited to Ayurveda
fraternity. For wider acceptance and to explain their
efficacy to modern world needs Scientific Validation.
In this regard a thorough research by incorporating
advanced techniques along with principles of
Ayurveda is of paramount necessity. Research based
standardization of the procedure helps in global
acceptance of Parasurgical procedures
CONCLUSION:
Parasurgical procedures are unique and one of the
greatest contributions of Ayurveda to the Surgical
Field. They come into play where Surgery faces
limitations. Scientific Validation of Parasurgical
procedures is necessary for the global acceptance of
our ancient science.
REFERENCES:
[1] Acharya Sushruta. Sushruta Samhita.
(Nibandha Sangraha commentary of Dalhana
Acharya and Nyayachandrika Panjika of Sri
Gayadasacarya on Nidanasthana). Edited by
Yadavji Trikamji, Reprint Edition., Varanasi;
Krishnadas Academy 1998, Sutra stana, 11th
chapter, verse no 6, 46pp
chapter, verse no 1-2, Dalhana commentary,
50pp

[8] Acharya Vagbhata. Ashtangahrdayam.
(Sarvangasundara commentary of arunadatta
and Ayurveda rasayana commentary of
Hemadri). Edited by Bhishagacharya
Harishastri Paradkar Vaidhya, Reprint Edition.,
Varanasi; Krishnadas Academy 2000, Sutra
stana, 26th
chapter, verse no 42, 323pp.
chapter, verse no 12-14, 118pp
chapter, verse no 5-7, 55pp
[11] Acharya Vagbhata. Ashtangahrdayam.
(Sarvangasundara commentary of arunadatta
and Ayurveda rasayana commentary of
Hemadri). Edited by Bhishagacharya
Harishastri Paradkar Vaidhya, Reprint Edition.,
Varanasi; Krishnadas Academy 2000, Sutra
stana, 26th
chapter, verse no 53-54, 325pp.
[12] P. Hemantha Kumar and M. Sahu, Role of
Aragvadhadi Sutra in the Management of
Fistula-in-ano, Ancient Science of Life, 2000,
Vol. XIX (3&4): 110-112. (ISSN 0257-7941).
[13] Gopikrishna and P. Hemantha Kumar, Effect of
Madhu Kshara Sutra in the management of
Bhagandara (Fistula-in-ano), International
Journal of Ayurvedic Medicine, 2013, Vol.
4(3), 237-241. (ISSN 0976-5921).
[14] Mahesh Kumar ES, Hemantha Kumar P, A case
discussion on effect of Palasha Kshara Sutra in
the management of Bhagandara (Fistula-in-ano)
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[15] Yadav Vikas S, Rao Prasanna N, P Hemantha
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[16] http://drchauhansblog.blogspot.in/2012/01/fistu
la-in-ano-and-ayurvedakshar-sutra.html
[17] Journal Of Vishwa Ayurveda Parishad Patrika
Oct-2012, Issue-9, Vol-9-10, By Dr Amit
Kumar Singh & Dr Pragya Mishra, p33
[18] Efficacy of Agnikarma with Rajat & Tamra
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[19] Efficacy of Agnikarma with Rajat & Tamra
shalaka on Janusandhigata vata by Dr Sucheta
Ray, RGUHS University, Dept of Shalyatantra,
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[20] Dr. Mohasin Kadegaon. A Text Book Of
Shalya Tantra, 1st
Edition., Varanasi;
Chaukhamba Orientalia 2020, 119pp
[21] J Vaneet Kumar, Tukaram S Dudhamal and S
K Gupta, V Mahanta, A Comparative Clinical
Study Of Siravedha And Agnikarma In
Management Of Gridhrasi, An International
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2014 Jul-Sep
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Kushwaha, Leech therapy in
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vishwabharati, Varanasi. page no117-121.
[24] Abdullah M. N. Al-Bedah et al. The medical
perspective of cupping therapy: Effects and
mechanisms of action. Journal of Traditional
and Complementary Medicine 9 (2019) 90-97

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